HomeMy WebLinkAboutFMC APP 3.18.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS -7-7<
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661 -852 -2171
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n i TNF_sF ❑ SB -989 SECONDARY CONTAINMENT
ELMONITORINGCER ICATION ❑ OVERFILL PREVENTION
NAME a PRONE # OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED? ❑ YES
❑ NO
VOLUME CONTENTS
TA11C TESTING :C OMPANY
PFfONE # OF ON ACT�����,J _�.-�j
TESTING COMPANY �Q
MAILING ADDRESS A-% CERTIFICATION
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
#
��
A ICC #
TEST METHOD Fil
DATE
APPLICANT SIGN RE
i
HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/18)